Multifamily Group to Reduce Marital Conflict and Disability in Veterans with mTBI

描述(由申请人提供)： 轻度创伤性脑损伤(MTBI)是一种与短暂意识丧失或精神状态改变相关的损伤或脑震荡，在最近的伊拉克和阿富汗军事行动中，多达35%的士兵受伤。高达30%的伤者报告了持续性的躯体、情绪和认知脑震荡后症状(PCS)，这可能对家庭生活和社区重新融合产生不利影响。婚姻冲突和亲密伴侣暴力，54%的OEF/OIF夫妇报告，以及共同发生的精神健康问题可能会加剧认知功能障碍和延误康复。婚姻冲突的一个关键因素是 对退伍军人的情况缺乏了解，缺乏帮助他弥补记忆和计划方面常见缺陷所需的技能，这给家庭管理带来了挑战。尽管夫妻治疗创伤后应激障碍的证据越来越多，但对于患有mTBI的OEF/OIF退伍军人还没有确定的基于家庭的治疗方法，这造成了严重的研究和服务缺口。这项拟议的研究旨在通过评估一种新的多家庭团体治疗形式来填补这一空白，该形式旨在通过培训配偶/伴侣以帮助康复并使用适应残疾的沟通和解决问题的技能来减少婚姻冲突和提高婚姻满意度，来改善患有mTBI的已婚/同居OEF/OIF退伍军人的社区融合(CI)。180名退伍军人(N=180)在OEF/OIF时代持续存在mTBI的DVBIC筛查阳性，并经退伍军人鉴定临床访谈和蒙特利尔认知评估(MoCA)得分e 19确认，将被随机分配接受以下两种之一：1)夫妇脑损伤多家庭小组(MFG-mTBI-C)，包括提供有关脑损伤信息的2节多家庭教育讲习班和12次双月多家庭小组会议，提供与认知/情绪缺陷有关的解决问题和沟通的技能培训；或2)14个双月一次的多家庭小组会议，提供与认知/情绪障碍有关的问题解决和沟通技能培训；或2)14个双月多家庭小组会议，提供无技能的健康教育 训练。在这两种治疗之前，都会有2-3次个人情侣会议。参与者将在治疗前和治疗后以及治疗后6个月进行评估。数据将使用意向治疗分析，并使用混合影响回归模型在治疗组之间关于主要(老兵CI、照顾者负担)和次要(愤怒管理、社会支持使用)结果变量的配对比较进行分析。研究假设：1)接受MFG-mTBI-C治疗的退伍军人将表现出更好的CI、愤怒管理和对社会支持的利用，与健康教育组相比，配偶/伴侣将表现出更少的负担；2)CI的改善将通过婚姻满意度、退伍军人愤怒管理和社会支持的改善来中介；3)认知功能在基线水平更完整的退伍军人将在CI、愤怒管理、社会支持和婚姻满意度方面表现出更大的改善。如果有效，MFG-mTBI-C有可能在退伍军人及其整个退伍军人医疗保健系统中帮助他们的合作伙伴。

DESCRIPTION (provided by applicant): Mild traumatic brain injury (mTBI), an injury or concussion associated with brief loss of consciousness or altered mental state, has affected as many as 35% of soldiers wounded during recent military actions in Iraq and Afghanistan. Up to 30% of those injured report persistent somatic, emotional and cognitive post- concussive symptoms (PCS) which may adversely impact family life and community re-integration. Marital conflict and intimate partner violence, reported by 54% of OEF/OIF couples, and co-occurring mental health problems may exacerbate cognitive dysfunction and delay rehabilitation. A key contributor to marital conflict is a lack of knowledge about the Veteran's condition and the skills needed to help him compensate for common deficits in memory and planning which create challenges in household management. Despite a growing evidence base for couples treatment for PTSD, there is no established family-based treatment for OEF/OIF Veterans with mTBI, creating a critical research and services gap. The proposed research aims to fill this gap by evaluating a novel form of multi-family group treatment designed to improve community integration (CI) among married/cohabiting OEF/OIF Veterans with mTBI by training spouse/partners to aid with rehabilitation and employing disability-adapted communication and problem-solving skills to reduce marital conflict and improve marital satisfaction. Veterans (N=180) with a positive DVBIC screen for mTBI sustained during the OEF/OIF era, confirmed by the VA Identification Clinical Interview and a Montreal Cognitive Assessment (MoCA) score e 19 will be randomized to receive either: 1) Multifamily Group for TBI for Couples (MFG-mTBI- C), a psychoeducational, rehabilitation and skills-building intervention consisting of a 2-session multifamily educational workshop providing information about TBI and 12 bi-monthly multifamily group meetings providing skills training in problem-solving and communication related to cognitive/emotional deficits; or 2) 14 bi-monthly multifamily group sessions delivering health education without skills training. Both treatments will be preceded by 2-3 individual couples sessions. Participants will be assessed pre- and post-treatment and 6 months post- treatment. Data will be analyzed using an intent-to-treat analysis with paired comparisons between treatment groups on primary (Veteran CI, caregiver burden) and secondary (anger management, use of social supports) outcome variables using mixed effects regression models. It is hypothesized that: 1) Veterans treated with MFG-mTBI-C will show improved CI, anger management and use of social support, and spouse/partners will show reduced burden compared with those treated in the health education group; 2) that improvement in CI will be mediated by improvement in marital satisfaction and Veteran anger management and social support; 3) that Veterans with more intact cognitive functioning at baseline will show greater improvement in CI, anger management, social support and marital satisfaction. If efficacious, MFG-mTBI-C has the potential to assist Veterans with mTBI and their partners throughout the VA Health Care System.